compensation arrangement

(1) Compensation arrangement; remuneration (A) The term “compensation arrangement” means any arrangement involving any remuneration between a physician (or an immediate family member of such physician) and an entity other than an arrangement involving only remuneration described in subparagraph (C). (B) The term “remuneration” includes any remuneration, directly or indirectly, overtly or covertly, in cash or in kind. (C) Remuneration described in this subparagraph is any remuneration consisting of any of the following: (i) The forgiveness of amounts owed for inaccurate tests or procedures, mistakenly performed tests or procedures, or the correction of minor billing errors. (ii) The provision of items, devices, or supplies that are used solely to— (I) collect, transport, process, or store specimens for the entity providing the item, device, or supply, or (II) order or communicate the results of tests or procedures for such entity. (iii) A payment made by an insurer or a self-insured plan to a physician to satisfy a claim, submitted on a fee for service basis, for the furnishing of health services by that physician to an individual who is covered by a policy with the insurer or by the self-insured plan, if— (I) the health services are not furnished, and the payment is not made, pursuant to a contract or other arrangement between the insurer or the plan and the physician, (II) the payment is made to the physician on behalf of the covered individual and would otherwise be made directly to such individual, (III) the amount of the payment is set in advance, does not exceed fair market value, and is not determined in a manner that takes into account directly or indirectly the volume or value of any referrals, and (IV) the payment meets such other requirements as the Secretary may impose by regulation as needed to protect against program or patient abuse. (D) Written requirement clarified .— In the case of any requirement pursuant to this section for a compensation arrangement to be in writing, such requirement shall be satisfied by such means as determined by the Secretary, including by a collection of documents, including contemporaneous documents evidencing the course of conduct between the parties involved. (E) Special rule for signature requirements .— In the case of any requirement pursuant to this section for a compensation arrangement to be in writing and signed by the parties, such signature requirement shall be met if— (i) not later than 90 consecutive calendar days immediately following the date on which the compensation arrangement became noncompliant, the parties obtain the required signatures; and (ii) the compensation arrangement otherwise complies with all criteria of the applicable exception.


42 USC § 1395nn(h)(1)

Scoping language

in this subparagraph
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